Despite progress in health insurance coverage over the past decade, millions of Americans are still struggling under the weight of medical debt. With 26 million Americans lacking health insurance in 2023, and many others underinsured, the healthcare landscape remains challenging. The Commonwealth Fund’s latest survey highlights the persisting barriers to accessing timely care and the financial burdens many face due to medical costs.
Why It Matters: Medical Debt Persists Despite Coverage Gains
While the Affordable Care Act (ACA) and recent policy efforts have significantly improved access to health insurance, they haven’t eliminated the financial strain caused by high out-of-pocket costs and medical debt. Even among those insured, the Commonwealth Fund’s survey shows that 23% of working-age adults were underinsured, meaning their insurance didn’t provide adequate financial protection against healthcare costs.
More than half (57%) of underinsured adults reported skipping necessary care due to cost, and 44% had medical or dental debt they were paying off over time. Medical debt is a persistent problem: 48% of adults with debt owe $2,000 or more, and many are struggling to pay off bills related to hospital stays or ongoing treatments for chronic conditions.
By the Numbers: Medical Debt and Its Impact
- 26 million Americans lacked health insurance in 2023.
- 23% of working-age adults were underinsured in 2024, despite having coverage all year.
- 57% of underinsured adults avoided needed healthcare due to cost.
- 44% of underinsured adults had medical or dental debt they were paying off over time.
- 48% of adults with medical debt owed $2,000 or more.
- 66% of underinsured adults had coverage through an employer, 16% were enrolled in Medicaid or Medicare, and 14% had a plan purchased in the marketplaces or the individual market.
- Medical debt is not just a financial issue — two out of five adults who delayed or skipped care due to cost reported that their health problems worsened as a result.
- 42% of adults who didn’t get care because of cost said it was for an ongoing health condition, 29% said it was for a new health problem, and 28% said it was for both.
- 41% of adults reported delaying or not getting dental care because of the cost.
- One in five respondents said they had delayed getting mental health care because of cost.
- Three in 10 people reported they were paying off medical debt, with underinsured adults reporting this at the highest rate.
- 83% of people with medical debt reported total debt loads of $500 or more, and nearly half said they were paying off $2,000 or more.
Recommendations from the Report
The Commonwealth Fund report made several recommendations to improve health insurance coverage and reduce the burden of medical debt:
- Protect consumers from medical debt by prohibiting medical debt from appearing on consumer credit reports, strengthening standards for hospital financial assistance programs, and capping interest on medical debt
- Permanently extend enhanced marketplace premium tax credits
- Fill the Medicaid coverage gap in the 10 states that have not expanded their programs
- Create a longer period of continuous medicaid eligibility
- Lower deductibles and out-of-pocket costs in marketplace plans
- Lower healthcare cost growth
